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What are common causes of heart murmurs?

DEAR DR. ROACH: My husband is 80 years old and survived liver cancer after receiving four years of immunotherapy. During a recent follow-up visit to his oncologist, the doctor told him he had a heart murmur. He takes medication for his thyroid and adrenal glands.

Could you please explain what a heart murmur is, what causes it and what treatment is recommended? Is it unusual for a heart murmur to appear suddenly? –MC

ANSWER: A heart murmur occurs when the examiner can hear blood flowing through one of the heart’s valves (or through a different heart structure, such as a patent ductus arteriosus or septal defect). This can occur with a damaged valve, such as a valve that is leaky (called stenosis) or a valve that is leaking, causing blood to flow in the wrong direction through the valve (called incompetence or insufficiency).

However, it can also be heard in some people with structurally normal hearts, especially when blood flow is high. High blood flow can occur when there is anemia or when thyroid levels are too high. Anemia is extremely common in people being treated for cancer, but after four years I would expect his blood count to return to normal. However, this is not always the case.

There are less common causes of heart murmurs. Infection can damage the valve, causing a murmur, and an enlarged heart can cause obstruction and a heart murmur. However, most of the time, a heart murmur in a young adult is “innocent” and does not indicate disease of the heart or its valves.

Given your husband’s age and medical history, it may be worth investigating further. The appearance of a murmur at one’s age is more concerning than in a younger person, because valvular diseases tend to occur at a later age. It is important to review his medical history because the murmur may have already been noticed and he may not have been informed of it. (I tell all my patients when I hear one for this reason.)

An expert can learn a lot about the heart by listening carefully and may be able to reassure you and your husband that the risk of serious illness is low. If the concern persists, an echocardiogram will almost always provide the answer.

DEAR DR. ROACH: My husband and I, both 78, will be traveling for several months to countries where the Centers for Disease Control and Prevention recommends the hepatitis B vaccine, which we have never received. After asking our GPs, talking to pharmacists, contacting the local Department of Health and consulting online, we are unable to get a clear answer on how many hepatitis B injections to receive or at what distance. space. Can you help ? We are leaving in three months. — PM

ANSWER: There are four different hepatitis B vaccines. Three of them are given in a three-dose series, with the second given one month after the first and the third six months later. However, one brand of vaccine (HepB-CpG) consists of a series of two doses, with the second dose given one month after the first. This will give you complete protection before your trip.

Dr. Roach regrets not being able to respond to individual letters, but he will incorporate them into the column as much as possible. Readers can email questions to ToYourGoodHealth@med.cornell.edu or mail to 628 Virginia Dr., Orlando, FL 32803.

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